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Bagaria V, Lahari B, Jagannath BR, Hiremath CS. Total Anomalous Pulmonary Venous Connection in Adults: Should We Offer Surgery? World J Pediatr Congenit Heart Surg 2024:21501351241232072. [PMID: 38654425 DOI: 10.1177/21501351241232072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background: We aim to determine the surgical outcomes of adult patients with total anomalous pulmonary venous connection (TAPVC) and examine the regression of pulmonary artery (PA) pressures after the procedure. Methods: We reviewed the hospital records from 2003 to 2022 and identified 49 adult patients with TAPVC. We assessed their surgical outcomes and the trend of PA pressures after the procedure. Continuous data are presented as mean ± SD or median (interquartile range) and categorical variables are presented as percentages. Results: The median age of the patients was 23 years (range 18-42) and 31 (63.3%) were male. Thirty-six patients (73.5%) had supracardiac TAPVC. The mean systolic PA pressure was 65.8 ± 16.4 mm Hg and it decreased by 47.9% (34%, 61.8%) after surgery. Moderate or more tricuspid regurgitation was seen in 27 (55.1%) patients before surgery; however, it was present in only 3 (6.1%) patients during early follow-up. There was no intraoperative or 30-day mortality, and the median hospital length of stay was six days. Long-term follow-up data were available for 29 patients with the average duration of follow-up being 5.6 years (range 6 months to 15 years) and the mean systolic PA pressures of this cohort was 29.8±7.9 mm Hg. Forty-six (93.1%) patients were asymptomatic; four women had uneventful pregnancies and delivered healthy children. Conclusion: Surgical repair of the naturally selected group of adult TAPVC patients can be performed safely with good results. Regression in flow-related pulmonary hypertension and an improvement in functional quality of life are seen in nearly all patients.
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Affiliation(s)
- Vivek Bagaria
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
- Department of Congenital Cardiac Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Badragiri Lahari
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - B R Jagannath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
| | - C S Hiremath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India
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Wadile S, Kondgekar D, Banpurkar AM, Raeen SP, Kulkarni K, Kulkarni S. How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country. Pediatr Cardiol 2024:10.1007/s00246-024-03486-w. [PMID: 38635040 DOI: 10.1007/s00246-024-03486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97 ± 2.79 months and 5.07 ± 1.16 kg, respectively. The mean follow-up duration was 8.99 ± 2.31 months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (- 3.67 ± 1.18 vs. - 1.76 ± 1.14, p = 0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8 months of age (2-4 months = 3588 g, 5-6 months = 3592 g, 7-8 months = 3606 g, 9-10 months = 2590 g, 11-12 months = 2250 g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.
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Affiliation(s)
- Santosh Wadile
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Divya Kondgekar
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Ashishkumar Moreshwar Banpurkar
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Shahena Parveen Raeen
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Komal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India
| | - Snehal Kulkarni
- Head of Department of Paediatric Cardiology and Mentor, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, Maharashtra, 410210, India.
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Joseph SP, Mirza SU, Krupa J, Varghese SI, Kartha GB, George OK, George PV, Jose J, Thomson VS. Original Article--Clinical and Procedural Characteristics of Successful Transcatheter Device Closure of Ostium Secundum Atrial Septal Defect in Symptomatic Children Weighing <15 kg: A Retrospective Study Spanning One Decade From South India. J Saudi Heart Assoc 2024; 36:14-22. [PMID: 38566902 PMCID: PMC10984675 DOI: 10.37616/2212-5043.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/07/2024] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives This retrospective study sought to determine the feasibility of transcatheter atrial septal defect device closure in patients less than 15 kg, as well as to assess complication rates and the reasons for unsuccessful device closure. Background In general, the risks associated with transcatheter atrial septal defect device closure are believed and reported to be relatively low, but the evidence stems from trials involving adults and older children. Current guidelines do not recommend atrial defect closure in device closure in children <15 kg, due to limited data available for feasibility and safety of device closure in this group of patients. Methods Retrospective review of all patients who underwent elective transcatheter closure of ostium secundum atrial septal defect between September 2013 to February 2022. We excluded all children above 15 kg, as well as those with complex congenital heart defects. Major and minor complications were predefined and indications for referral were evaluated. Results We identified 81 patients meeting criteria with a median procedural age of 3 years (1 year-8 years), and median weight of 12 kg (4-15 kg). Successful device closure was achieved in 95.1% (77/81) and in 4.9% (4/81), the procedure was aborted. There was 1 major (1.2%) and 1 minor (1.2%) complication, total complication rate (2.4%). 100% of the referrals had right heart enlargement and exertional dyspnoea, 18.5% had recurrent lower respiratory tract infection and 9.9% had failure to thrive. Rate of resolution of residual shunt was 95.1%. at post-procedure day 1 and 98.8% at post-procedure 3 and 6 months respectively. Conclusions Percutaneous atrial septal defect closure can be done effectively and safely in symptomatic children weighing less than 15 kg in experienced centres. However, deferral for closure until the historically established timeline of around 4-5 years of age should be strongly considered in asymptomatic children.
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Affiliation(s)
- Shobhit P. Joseph
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shohiab U.R. Mirza
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Jesu Krupa
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Shruti I. Varghese
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Gayathri B. Kartha
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Oommen K. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Paul V. George
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - John Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
| | - Viji S. Thomson
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu,
India
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He Q, Song M, Huang Y, Wan L. Perioperative care of neonates with critical pulmonary stenosis: Case report. Medicine (Baltimore) 2024; 103:e37203. [PMID: 38394548 DOI: 10.1097/md.0000000000037203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
RATIONALE Summarizing the perioperative nursing experience in the successful treatment of 4 neonates with critical pulmonary stenosis (CPS). PATIENT CONCERNS Of the 4 patients, 3 had postnatal shortness of breath and varying degrees of cyanosis, aggravated by crying and noise, and 1 had no obvious shortness of breath and cyanosis. The preoperative auscultation of the precordial region could be heard 3-4/6 systolic murmur; echocardiography was diagnosed as CPS, combined with patent ductus arteriosus, right ventricular dysplasia, and severe tricuspid regurgitation. Four children were treated with prostaglandin 5 ng/(kg-min) to maintain a certain degree of pulmonary blood flow to improve hypoxemia, effectively preventing ductus arteriosus from closure, and the infusion was discontinued 2 hours prior to the operation. Three of the children required ventilator-assisted respiration to relieve severe hypoxia and correct acidosis before surgery. DIAGNOSIS Neonatal CPS was diagnosed. INTERVENTIONS Four neonates with rapidly developing conditions were admitted to the hospital, a multidisciplinary in-hospital consultation was organized immediately, and a multidisciplinary collaborative team was set up, consisting of medical doctors and nurses from the medical department, the neonatal intensive care unit, cardiovascular medicine, cardiac ultrasound room, anesthesiology department, and radiology and interventional medicine department. The multidisciplinary team evaluated the treatment modality of the children and finally decided to perform percutaneous balloon pulmonary valvuloplasty. The surgical team included specialists from the Department of Cardiovascular Medicine, Department of Interventional Radiology, Cardiac Ultrasound Unit, and Department of Anesthesiology. OUTCOMES All 4 neonates were successfully operated and discharged from the hospital. Multidisciplinary follow-up interventions were carried out 1 year after discharge, and the children were in good condition. LESSONS The specialty nursing-led multidisciplinary collaboration model significantly improves the professional competence of nurses from various specialties, promotes the integration and development of multispecialty disciplines, and provides better quality services for children, which is the key to improving the success rate of percutaneous balloon pulmonary valvuloplasty in neonates.
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Affiliation(s)
- Qiong He
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 433000, China
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Sharma A, Arya A, Wadile S, Borgohain S, Kulkarni S. Pseudoaneurysm of aorta after transcatheter closure of patent ductus arteriosus. Indian J Thorac Cardiovasc Surg 2024; 40:103-106. [PMID: 38125334 PMCID: PMC10728411 DOI: 10.1007/s12055-023-01619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 12/23/2023] Open
Abstract
Aortic pseudoaneurysm is a rare but life-threatening complication after transcatheter closure of patent ductus arteriosus (PDA) with only a few reported cases in literature. We report a case of an 18-month-old child who was diagnosed to have pseudoaneurysm of the aorta after 6 months of transcatheter closure of PDA. It was diagnosed on routine follow-up on echocardiography evaluation. Computed tomography chest is the imaging modality of choice for evaluation of these patients which showed large saccular aneurysm arising from distal aortic arch beyond origin of left subclavian artery. Any aneurysm more than 30 mm should be treated irrespective of symptoms. Treatment modalities are surgical resection of the aneurysm (as in our patient) or thoracic endovascular aortic repair. In our case, surgical resection of aneurysm was performed. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-023-01619-z.
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Affiliation(s)
- Anuj Sharma
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani International Centre for Child Heart Care & Research, Baghola, NH-2, Delhi-Mathura Road, Palwal (District), Haryana, 121102 India
| | - Adhi Arya
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani International Centre for Child Heart Care & Research, Baghola, NH-2, Delhi-Mathura Road, Palwal (District), Haryana, 121102 India
| | - Santosh Wadile
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, 410210 Maharashtra India
| | - Shyamadeep Borgohain
- Department of Pediatric Cardiac Surgery, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, 410210 Maharashtra India
| | - Snehal Kulkarni
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Centre for Child Heart Care & Training in Pediatric Cardiac Skills, Kharghar, Navi Mumbai, 410210 Maharashtra India
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Bhende VV, Sharma TS, Sharma AS, Subramaniam KG, Kumar A, Tandon KR, Sharma D, Panesar G, Soni K, Dhami KB, Pathan SR, Patel N, Majmudar HP. Utility of Conventional but Late Pulmonary Artery Banding in Complex Cyanotic Congenital Heart Disease in a Toddler - A Single Case Scenario. Cureus 2023; 15:e35452. [PMID: 36851945 PMCID: PMC9961731 DOI: 10.7759/cureus.35452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Newborns with untreated single ventricles develop pulmonary vascular diseases early in their lives. At that age, during the first eight weeks after birth, clinicians perform pulmonary artery (PA) banding to reduce the blood flow to the lung, decreasing the likelihood of future high vascular resistance or pressure. PA banding is also considered an initial stage in the process of single ventricle palliation procedures. We report a case of a 16-month-old toddler (7 kg) with room air saturation of 82%, diagnosed with tricuspid valve atresia, large atrial and ventricular septal defect, and hypoplastic right ventricle with severe pulmonary arterial hypertension. The baby underwent a successful surgical procedure of PA banding and was discharged after 13 days of hospital stay with a room air saturation of 89%. This case highlighted the benefit of PA banding beyond the stipulated period.
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Affiliation(s)
- Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND.,Community Medicine, Sal Institute of Medical Sciences, Ahmedabad, IND
| | - Ashwin S Sharma
- Medicine, Gujarat Cancer Society Medical College, Hospital and Research Centre, Ahmedabad, IND
| | | | - Amit Kumar
- Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Krutika R Tandon
- Pediatrics, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Dhruva Sharma
- Cardiothoracic and Vascular Surgery, Sawai Man Singh (SMS) Medical College and Hospital, Jaipur, IND
| | - Gurpreet Panesar
- Cardiac Anesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Kunal Soni
- Cardiac Anesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Kartik B Dhami
- Cardiac Anesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Sohilkhan R Pathan
- Clinical Research Services, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Nirja Patel
- Cardiac Anesthesiology, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Hardil P Majmudar
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
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Ramakrishnan S. Annals of Pediatric Cardiology: A new look and a new outlook. Ann Pediatr Cardiol 2023; 16:1-3. [PMID: 37287844 PMCID: PMC10243659 DOI: 10.4103/apc.apc_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 06/09/2023] Open
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Alkanhal A, Ducas R, Mackie AS, Seaman C, Averin K, Mah K, Khoury M. Practice Patterns in the Management of Pressure Restrictive Perimembranous Ventricular Septal Defects: A Multinational Survey. Pediatr Cardiol 2022. [PMID: 36538052 DOI: 10.1007/s00246-022-03073-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Indications for the closure of pressure restrictive perimembranous ventricular septal defects (pmVSD) are not well established in the pediatric population. We sought to assess practice variability among pediatric cardiologists in the United States (US), Canada, Australia, and New Zealand. A survey ascertaining practice patterns, including case vignettes with incremental progression of disease severity, was designed and administered through representative professional cardiac organizations and email listservs in the designated countries. Among the 299 respondents, 209 (70.0%) were from the US, 65 (21.7%) were from Canada and 25 (8.3%) were from Australia and New Zealand. Indications for pressure restrictive pmVSD closure included the presence of left ventricular (LV) dilation for 81.6% (244/299) (defined as z-score ≥ 2 for 59.0% (144/244) and ≥ 3 for 40.2% (98/244)) and significant pulmonary-systemic flow ratio (QP:QS) for 71.2% (213/299) [defined as ≥ 1.5:1 for 36.2% (77/213) and ≥ 2 for 62% (132/213)]. US pediatric cardiologists elected to close restrictive pmVSD at lower LV z-score and QP:QS ratio cut-offs (p-value 0.0002 and 0.013, respectively). In a case vignette, 63.6% (173/272) chose to intervene if there was right coronary cusp prolapse with stable mild aortic regurgitation. Of the remaining cardiologists, 93% (92/99) intervened if the aortic regurgitation was progressive (from trivial to mild). Commonly identified indications with variable thresholds for closure of pressure restrictive pmVSDs included the presence or progression of LV dilation, significant volume loading, and aortic valve prolapse with regurgitation. US pediatric cardiologists may have a lower threshold for pmVSD closure.
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Ezemba N, Chinawa JM, Adiele DK, Arodiwe IO, Ujunwa FA, Okorie CO. Outcomes of Surgical Management for Patent Ductus Arteriosus in Infants in Nigeria. Tex Heart Inst J 2022; 49:489125. [PMID: 36511942 PMCID: PMC9809069 DOI: 10.14503/thij-21-7633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patent ductus arteriosus is a common cardiac anomaly in infants that, if untreated, is associated with high morbidity and mortality rates. In lower-middle-income countries, such as Nigeria, obtaining cardiovascular surgical care for infants remains difficult. In recent years, especially with the assistance of international voluntary cardiac organizations, efforts have increased to provide cardiac surgical services to this underserved population. METHODS In this case series, the authors describe outcomes in 30 infants surgically treated for patent ductus arteriosus between 2013 and 2019 at an emerging cardiac center in Nigeria (9 male [30%] and 21 female [70%]; mean [SD] age, 8.2 [3.01] months; mean [SD] weight, 5.3 [1.52] kg; mean [range] weight deficit, 34.5% [15%-60%]). RESULTS All the infants presented with patent ductus arteriosus as the main cardiac lesion, and 4 (13%) were syndromic. The mean (SD) patent ductus arteriosus diameter was 4.73 (1.46) mm. Surgical closure was completed in 29 infants; 1 died before surgery. No procedure-related deaths occurred, but 2 cases of trivial residual patent ductus arteriosus were recorded. CONCLUSION Overall, surgical outcomes were excellent, with acceptable mortality rates. Perioperative care will continue to improve as the center is built to a self-sustaining capacity. Findings of this research at this emerging cardiac center in a developing country are a testament to the positive contribution made by international voluntary cardiac missions.
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Affiliation(s)
- Ndubueze Ezemba
- Division of Cardiothoracic Surgery, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Josephat M. Chinawa
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Daberechi K. Adiele
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Ijeoma O. Arodiwe
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Fortune A. Ujunwa
- Division of Pediatric Cardiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Chukwuemeka O. Okorie
- Division of Anesthesiology, National Cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
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Shakya A, Shakya U, Shrestha M, Shah SC, Aryal PSS, Bhandari Kc V, Thapa KR. Follow up and outcome of transcatheter device closure in pediatric patients in a tertiary cardiac centre of Nepal. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chi IB, Scansen BA, Potter BM, Pierce KV, Gagnon AL, Sloan CQ. Transcatheter Closure of Aneurysmal Perimembranous Ventricular Septal Defect with the Canine Duct Occluder in Two Dogs. J Vet Cardiol 2022. [DOI: 10.1016/j.jvc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022]
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12
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Meidell Blylod V, Rinnström D, Pennlert J, Ostenfeld E, Dellborg M, Sörensson P, Christersson C, Thilén U, Johansson B. Interventions in Adults With Repaired Coarctation of the Aorta. J Am Heart Assoc 2022; 11:e023954. [PMID: 35861813 PMCID: PMC9707821 DOI: 10.1161/jaha.121.023954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Coarctation of the aorta coexists with other cardiac anomalies and has long‐term complications, including recoarctation, which may require intervention after the primary coarctation repair. This study aims to clarify the prevalence of and risk factors for interventions related to the coarctation complex as well as late mortality in a large contemporary patient population.
Methods and Results
The Swedish National Register of Congenital Heart Disease was used, which comprised 683 adults with repaired coarctation of the aorta. Analysis was performed on freedom from intervention thereafter at the coarctation site, aortic valve, left ventricular outflow tract, or ascending aorta. One hundred ninety‐six (29%) patients had at least 1 of these interventions. Estimated freedom from either of these interventions was 60% after 50 years. The risk of undergoing such an intervention was higher among men (hazard ratio, 1.6 [95% CI, 1.2–2.2]). Estimated freedom from another intervention at the coarctation site was 75% after 50 years. In women, there was an increase in interventions at the coarctation site after 45 years. Patients who underwent one of the previously mentioned interventions after the primary coarctation repair had poorer left ventricular function. Eighteen patients (3%) died during follow‐up in the register. The standardized mortality ratio was 2.9 (95% CI, 1.7–4.3).
Conclusions
Interventions are common after coarctation repair. The risk for and time of interventions are affected by sex. Our results have implications for planning follow‐up and giving appropriate medical advice to the growing population of adults with repaired coarctation of the aorta.
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Affiliation(s)
| | - Daniel Rinnström
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
| | - Johanna Pennlert
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund Clinical Physiology, Lund University Lund Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine University of Gothenburg Gothenburg Sweden
| | - Peder Sörensson
- Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | | | - Ulf Thilén
- Department of Clinical Sciences Lund Cardiology, Lund University Lund Sweden
| | - Bengt Johansson
- Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
- Department of Surgical and Perioperative Sciences Umeå University Umeå Sweden
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Kumar P, Bhatia M. Role of CT in the Pre- and Postoperative Assessment of Conotruncal Anomalies. Radiol Cardiothorac Imaging 2022; 4:e210089. [PMID: 35923747 PMCID: PMC9308465 DOI: 10.1148/ryct.210089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/25/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
Conotruncal anomalies, also referred to as outflow tract anomalies, are congenital heart defects that result from abnormal septation of the great vessels' outflow tracts. The major conotruncal anomalies include tetralogy of Fallot, double-outlet right ventricle, transposition of the great arteries, truncus arteriosus, and interrupted aortic arch. Other defects, which are often components of the major anomalies, include pulmonary atresia with ventricular septal defect, pulmonary valve agenesis, aortopulmonary window, and double-outlet left ventricle. CT has emerged as a robust diagnostic tool in preoperative and postoperative assessment of various congenital heart diseases, including conotruncal anomalies. The data provided with multidetector CT imaging are useful for treatment planning and follow-up monitoring after surgery or intervention. Unlike echocardiography and MRI, CT is not limited by a small acoustic window, metallic devices, and need for sedation or anesthesia. Major advances in CT equipment, including dual-source scanners, wide-detector scanners, high-efficiency detectors, higher x-ray tube power, automatic tube current modulation, and advanced three-dimensional postprocessing, provide a low-risk, high-quality alternative to diagnostic cardiac catheterization and MRI. This review explores the various conotruncal anomalies and elucidates the role of CT imaging in their pre- and postoperative assessment. Keywords: CT, CT Angiography, Stents, Pediatrics © RSNA, 2022.
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Affiliation(s)
- Parveen Kumar
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
| | - Mona Bhatia
- Department of Radiodiagnosis and Imaging, Fortis Escort Heart Institute, Okhla Road, New Delhi 110025, India
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Venugopal ST, Natarajan S, Arakeri MP, Seshadri S. Master Frame Extraction of Fetal Cardiac Images Using B Mode Ultrasound Images. JBBBE 2022; 54:51-64. [DOI: 10.4028/www.scientific.net/jbbbe.54.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fetal Echocardiography is used for monitoring the fetal heart and for detection of Congenital Heart Disease (CHD). It is well known that fetal cardiac four chamber view has been widely used for preliminary examination for the detection of CHD. The end diastole frame is generally used for the analysis of the fetal cardiac chambers which is manually picked by the clinician during examination/screening. This method is subjected to intra and inter observer errors and also time consuming. The proposed study aims to automate this process by determining the frame, referred to as the Master frame from the cine loop sequences that can be used for the analysis of the fetal heart chambers instead of the clinically chosen diastole frame. The proposed framework determines the correlation between the reference (first) frame with the successive frames to identify one cardiac cycle. Then the Master frame is formed by superimposing all the frames belonging to one cardiac cycle. The master frame is then compared with the clinically chosen diastole frame in terms of fidelity metrics such as Dice coefficient, Hausdorff distance, mean square error and structural similarity index. The average value of the fidelity metrics considering the dataset used for this study 0.73 for Dice, 13.94 for Hausdorff distance, 0.99 for Structural Similarity Index and 0.035 for mean square error confirms the suitability of the proposed master frame extraction thereby avoiding manual intervention by the clinician. .
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Awasthy N, Bhatt A, Kumar G. Echocardiography in Planning Aortic Arch Interventions. J Indian Acad Echocardiogr Cardiovasc Imaging 2022. [DOI: 10.4103/jiae.jiae_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Arora H, Vidya PL, Ghosh A, Mishra S, Shouche S, Sethi B, Mishra S, Nagi G. Midterm safety and outcome of balloon angioplasty of native aortic coarctation in neonates and young infants and initial experience of prepartial dilatation using high-pressure noncompliant balloon. Ann Pediatr Cardiol 2022; 15:121-127. [PMID: 36246746 PMCID: PMC9564400 DOI: 10.4103/apc.apc_197_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications. Aim: This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon. Materials and Methods: Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all. Results: A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34–80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A (P < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients (P < 0.001), in those with borderline/mildly hypoplastic arch (P = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg (P = 0.02). Median time to re-coarctation was significantly delayed in Group B (P < 0.001). There were no major complications or mortality in either group. Conclusions: BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.
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Verma S, Gouthami V. Role of Echocardiography in Balloon Dilatation of Aortic Valve. J Indian Acad Echocardiogr Cardiovasc Imaging 2022. [DOI: 10.4103/jiae.jiae_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Ramakrishnan S, Ghati N, Ahuja RS, Bhatt KN, Sati HC, Saxena A, Kothari SS. Efficacy and safety of propranolol in infants with heart failure due to moderate-to-large ventricular septal defect (VSD-PHF study) - A prospective randomized trial. Ann Pediatr Cardiol 2021; 14:331-340. [PMID: 34667404 PMCID: PMC8457270 DOI: 10.4103/apc.apc_94_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/10/2021] [Indexed: 01/16/2023] Open
Abstract
AIMS The utility of beta-blocker therapy in infants with heart failure (HF) due to significant left-to-right shunt lesions is not known. The study aimed to assess the efficacy and safety of propranolol in infants with HF due to moderate-to-large ventricular septal defect (VSD). METHODS The prospective randomized trial included 80 infants with HF and moderate-to-large VSD, randomly allocated to receive either conventional therapy alone (n = 40) or propranolol plus conventional therapy (n = 40). The primary endpoint was a composite of all-cause mortality, hospitalization for HF and/or chest infection, and referral for surgery. The secondary clinical outcomes were the individual components of the composite endpoint. In addition, the patients were followed up to detect safety outcomes, for example, bronchospasm, bradyarrhythmia, and worsening HF symptoms. RESULTS The addition of propranolol therapy to the conventional medications did not result in significant improvement in the primary composite endpoint (32.50% vs. 52.50%; P = 0.07). There was a trend toward improvement, but the study is underpowered for this important question. However, propranolol therapy significantly decreased the risk of hospitalization (12.50% vs. 32.50%; P = 0.03) and worsening of Ross HF class (5.41% vs. 28.21%; P = 0.01) as compared to conventional therapy (estimated number needed to treat = 5). Propranolol did not result in any significant safety concerns in these infants except bronchospasm in an infant. CONCLUSIONS Propranolol therapy in infants with significant left-to-right shunt may prevent worsening in HF symptoms and hospitalization and is well tolerated. However, it does not reduce mortality or need for surgery.
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Affiliation(s)
| | - Nirmal Ghati
- Department of Cardiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ramandeep Singh Ahuja
- Department of Cardiology, Krishna Hospital and Research Centre, Haldwani, Uttarakhand, India
| | | | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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Batta A, Verma S, Panda P, Sharma YP. Missed case of fever of unknown origin during COVID-19 pandemic: patent ductus arteriosus endarteritis. BMJ Case Rep 2021; 14:14/5/e243727. [PMID: 34045206 PMCID: PMC8162100 DOI: 10.1136/bcr-2021-243727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 40-year-old woman presented with fever of unknown origin (FUO) for 2 months. Without a definitive diagnosis and having received multiple empirical antibiotics from outside without relief, she was referred to our centre. Cardiac auscultation was remarkable for a grade 3/6 continuous murmur in the upper left sternal border. Echocardiogram revealed a patent ductus arteriosus (PDA) and a 5×7 mm mobile vegetation at the pulmonary artery bifurcation. Blood culture grew Streptococcus mutans. Embolisation of the vegetation to the pulmonary circulation occurred after the start of intravenous antibiotics resulting in fever relapse. Antibiotics were continued for 6 weeks and the fever settled. She underwent device closure of PDA after 12 weeks and is currently doing fine. Infective endocarditis/endarteritis is an important differential in a patient of FUO. A thorough clinical examination is important in every case of FUO, gives an important lead into diagnosis and guides appropriate investigations to confirm it.
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Murni IK, Wirawan MT, Patmasari L, Sativa ER, Arafuri N, Nugroho S, Noormanto. Delayed diagnosis in children with congenital heart disease: a mixed-method study. BMC Pediatr 2021; 21:191. [PMID: 33882901 PMCID: PMC8059230 DOI: 10.1186/s12887-021-02667-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/13/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Delayed diagnosis of congenital heart disease (CHD) causes significant morbidity and mortality. We aimed to determine the proportion of delayed diagnosis of CHD and factors related to the delayed diagnosis. METHODS A prospective cohort study with mixed-methods was conducted in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Patients aged < 18 years with newly diagnosed CHD and echocardiography confirmed CHD were included. Data were recorded from medical records and interviews from direct caregivers. Logistic regression was used to identify independent factors associated with the delay. RESULTS A total of 838 patients were included with median age of 2.9 years (0-17.7 years), with female predominance (54.2%, n = 454). The proportions of delayed diagnosis were 60.8% (510), 54.9% (373) and 86.2% (137) in all children with CHD, acyanotic and cyanotic CHD, respectively. Delayed diagnosis by doctor was the most common cause, followed by delayed diagnosis related to midwifery care, financial, referral/follow-up, and social factors. In multivariate analysis, cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. At diagnosis, heart failure and pulmonary hypertension occurred in 414 (49.4%) and 132 (15.8%) children with CHD, respectively. CONCLUSIONS Six in ten children with CHD were diagnosed with significant delay. Delayed diagnosis by doctor was the most common cause. Children with cyanotic CHD, residence outside the city, non-syndromic, low family income, normal labour and at term gestation at birth were independently associated with the delay. Comorbid complications in delayed diagnosis of CHD were prevalent.
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Affiliation(s)
- Indah K Murni
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia.
| | - Muhammad Taufik Wirawan
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Linda Patmasari
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Esta R Sativa
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Nadya Arafuri
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Sasmito Nugroho
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
| | - Noormanto
- Department of Child Health, Dr. Sardjito Hospital / Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Kesehatan No 1, Sekip, Yogyakarta, 55281, Indonesia
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Saxena A, Relan J. Authors' reply. Ann Pediatr Cardiol 2020; 13:376-377. [PMID: 33311936 PMCID: PMC7727901 DOI: 10.4103/apc.apc_174_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Jay Relan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
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Naganur SH, Vijay J, Barwad P. Anticoagulation for atrial fibrillation in children; one size doesn't fit all! Ann Pediatr Cardiol 2020; 13:375-376. [PMID: 33311935 PMCID: PMC7727916 DOI: 10.4103/apc.apc_122_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Jyothi Vijay
- Department of cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
| | - Parag Barwad
- Department of cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
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Sagar P, Sivakumar K. A covered stent used in aortic coarctation migrates proximally during deployment causing transverse arch obstruction: Transcatheter repositioning after one month. J Cardiol Cases 2020; 24:23-26. [PMID: 34257756 DOI: 10.1016/j.jccase.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
Stent angioplasty with covered stents to avoid risk of aortic injury is the preferred mode of management of coarctation of aorta in adults and older children. Severe isthmic coarctation in an adult male with uncontrolled systemic hypertension was managed at another institution using a covered stent. A proximal stent migration during deployment resulted in obstruction of transverse aortic arch and left subclavian artery and was recognized one month after the procedure. This resulted in significant aortic gradients and left arm hypoperfusion. It was managed successfully by use of snares and additional overlapping stents, the first of this type in literature. Awareness of factors leading to stent migration and techniques involved in repositioning these stents may help cardiologists who deal with these interventions. <Learning objective: Distal stent migration is a known complication of coarctation stenting, often managed by expanding the stent in descending thoracic aorta where there are no major branches. However, proximal migration of covered stent leads to aortic arch obstruction including occlusion of arch branches. Techniques of delayed percutaneous repositioning of covered stent are described in this report.>.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
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Mukherji A, Ghosh S, Pathak N, Das JN, Dutta N, Das D, Chattopadhyay A. Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up. Ann Pediatr Cardiol 2020; 14:26-34. [PMID: 33679058 PMCID: PMC7918013 DOI: 10.4103/apc.apc_128_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/27/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period. Materials and Methods: This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding. Results: The median age of the patients was 5.5 months (3.5–96 months), and the median body weight was 4.7 kg (3.2–22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7–23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery. Conclusions: Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.
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Affiliation(s)
- Aritra Mukherji
- Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sanjiban Ghosh
- Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nihar Pathak
- Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Jayita Nandi Das
- Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Pediatric Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Debasis Das
- Department of Pediatric Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Amitabha Chattopadhyay
- Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
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Sasikumar N, Kato A. Indications for Intervention for Coarctation of the Aorta. Ann Pediatr Cardiol 2020; 13:272-273. [PMID: 32863671 PMCID: PMC7437620 DOI: 10.4103/apc.apc_21_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/21/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Navaneetha Sasikumar
- Consultant Pediatric Cardiologist, Department of Cardiothoracic and Vascular Surgery, Government Medical College, Kottayam, Kerala, India. E-mail:
| | - Atsuko Kato
- Department of Perinatal and Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Aziz S, Ayub M, Masood L, Amanullah M, Hameed R, Hashmi S, Ahmad W. Major Septal Defects: Comparative Study of Down Syndrome and Non-Down Syndrome Infants, Before and After Surgery. Pak J Med Sci 2020; 36:925-929. [PMID: 32704265 PMCID: PMC7372654 DOI: 10.12669/pjms.36.5.1743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan. Methods: We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded. Results: In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower in DS patients compared to non-DS patients: 7.0 vs 23.0 months, 0.311 vs 0.487 m2, and 63 vs 82 cm, respectively. Bypass duration, aortic cross clamp time, post-operative ventilator hours, dose of inotropes, CICU stay, and total hospital stay were all significantly higher in the DS group. The odds ratio (955% CI) for mortality in DS babies was 6.2 (1.4, 27.1), p=0.015, after adjusting for age, weight, and height. The overall morbidity was comparable between the two groups, demonstrating no significant difference after adjusting for confounders. Conclusion: DS babies with AVSD and inlet VSD are at a greater risk of mortality compared to non-DS babies, particularly those with CAVSD. Furthermore, DS babies undergo surgery at a younger age and require more aggressive post-operative therapy and monitoring due to the development of complications.
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Affiliation(s)
- Saleha Aziz
- Saleha Aziz Medical Student, Aga Khan University, Karachi, Pakistan
| | - Maaha Ayub
- Maaha Ayub Medical Student, Aga Khan University, Karachi, Pakistan
| | - Laiba Masood
- Laiba Masood Medical Student, Aga Khan University, Karachi, Pakistan
| | - Muneer Amanullah
- Prof. Dr. Muneer Amanullah Professor of Pediatric Cardiothoracic Surgery, NICVD; Karachi, Pakistan
| | - Rukhsana Hameed
- Dr. Rukhsana Hameed Head of Department, Maternal and Child Health, Institute of Public Health, Lahore, Pakistan
| | - Shiraz Hashmi
- Shiraz Hashmi Analyst, Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan
| | - Waris Ahmad
- Dr. Waris Ahmad Assistant Professor, Pediatric Cardiothoracic Surgery, Aga Khan University, Karachi, Pakistan
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Abstract
Congenital heart diseases have varied presentations depending on the age of presentation. Regression of neonatal pulmonary hypertension and the timing of establishment of left to right shunt determines the onset of symptoms. Pre-tricuspid shunts generally remain asymptomatic during the childhood while large post-tricuspid shunts present with heart failure in late neonatal or early infancy period. Admixture lesions have pathophysiology similar to large post tricuspid shunts with additional small right to left shunt causing mild systemic desaturation. Murmurs are prominent in valvular heart diseases. Careful clinical assessment of features of high pulmonary blood flow, presence of absence of systemic desaturation, status of second heart sound and murmur would help to arrive at a reasonable bedside diagnosis.
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Affiliation(s)
- Bhava Rj Kannan
- Department of Pediatric Cardiology, Vadamalayan Hospital, Madurai, India.
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28
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Saxena A, Relan J. Author's reply. Ann Pediatr Cardiol 2020; 13:273. [PMID: 32863672 PMCID: PMC7437612 DOI: 10.4103/apc.apc_32_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/21/2020] [Indexed: 11/22/2022] Open
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